A Not So Quiet Revolution: The Role of the Courts in Health System Change David Hyman
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A Not So Quiet Revolution: The Role of the Courts in Health
System Change
David HymanUniversity of Maryland/Illinois
Schools of LawFederal Trade Commission
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What Bodies of Law are we talking about?
• Insurance Law (McCarran-Ferguson Act/ERISA)
• Pilot Life v. Dedeaux (1987) • Pegram v. Herdrich (2000)• Rush Prudential v. Moran (2002)• Kentucky Assn. Health Plans v. Miller (2003)• Davila v. Aetna/Prudential (2004)
• Malpractice • Competition Law (Antitrust)• Fraud/Abuse
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What’s at stake?
• Federalism
• Tort v. Contract
• Lawyers/Doctors v. MCOs
• Fundamental Structural Issues
• Politics
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How Do Courts Affect The Medical Market?
• Market Entry/Exit (CON, AWP, FOC, Licensure, SSH)
• Structure/Substantive Content • Mergers • Fiduciary Obligations (PBMs)• Class Actions• Licensure/Malpractice
• Price/Quality
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Sources of Regulatory Oversight
1/6 Federal (Medicare)
1/6 None (Uninsured)
1/4 Federal: Self-Funded
1/6 Federal/State: Medicaid
1/4 Federal/State: Insured (Employment-based and Individual)
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What Role for HSR? What Role for HSR?
Quality as an empirical proposition Quality as an empirical proposition Quality from a population perspectiveQuality from a population perspective Study ERISA plansStudy ERISA plans Get Involved! Get Involved!
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What if What if Better Better Information Information Was Was Available Available from HSR? from HSR?